What questions should be asked to diagnose Post-Traumatic Stress Disorder (PTSD)?

Questions to Ask to Diagnose PTSD

Begin by directly asking: "Has anything scary or concerning happened to you or your child since the last visit?" followed by "What has happened to you (or your family)?" to explore trauma exposure, as these open-ended questions are essential for identifying PTSD since patients actively avoid discussing traumatic events. 1

Core Diagnostic Questions Based on DSM Criteria

Trauma Exposure Assessment

• Ask about direct exposure to actual or threatened death, serious injury, or sexual violence 2, 3, 4
• Inquire about witnessing traumatic events happening to others 2
• Ask if they learned about trauma happening to close family members or friends 2
• For professionals, ask about repeated exposure to details of traumatic events 2

Intrusion Symptoms (Need at least 1)

• "Do you have recurrent, unwanted distressing memories of the traumatic event?" 2, 5
• "Do you have nightmares about what happened?" 2, 5
• "Do you ever feel like the traumatic event is happening again (flashbacks)?" 2, 3, 4
• "Do you experience intense psychological distress when reminded of the trauma?" 2, 3, 4
• "Do you have physical reactions (sweating, heart racing) when something reminds you of the event?" 3, 4

Avoidance Symptoms (Need at least 1)

• "Do you avoid thinking about or talking about the traumatic event?" 2, 3, 4
• "Do you avoid places, people, activities, or situations that remind you of the trauma?" 2, 3, 4

Negative Alterations in Cognition and Mood (Need at least 2)

• "Are there important parts of the traumatic event you cannot remember?" 2, 3, 4
• "Do you have persistent negative beliefs about yourself, others, or the world?" 2
• "Do you blame yourself or others for what happened in a distorted way?" 2
• "Have you lost interest in activities you used to enjoy?" 2, 3, 4
• "Do you feel detached or estranged from other people?" 2, 3, 4
• "Are you unable to experience positive emotions?" 2
• "Do you feel your future is shortened or that you won't live a normal lifespan?" 3, 4

Alterations in Arousal and Reactivity (Need at least 2)

• "Have you been more irritable or had angry outbursts?" 2, 3, 4
• "Do you engage in reckless or self-destructive behavior?" 2
• "Are you constantly on guard or watchful (hypervigilance)?" 2, 3, 4
• "Do you have an exaggerated startle response?" 2, 3, 4
• "Do you have difficulty concentrating?" 2, 3, 4
• "Do you have trouble falling or staying asleep?" 2, 3, 4

Duration and Functional Impairment

• "How long have these symptoms been present?" (Must be >1 month for PTSD diagnosis) 2, 3, 4
• "Do these symptoms cause significant problems in your work, relationships, or daily activities?" 2, 3, 4

Age-Specific Considerations for Children

Additional Pediatric Questions

• Ask parents: "What did your child see or experience during the event?" 1
• "What does your child understand about what happened?" 1
• "Have you noticed sleep problems, nightmares, or difficulty awakening?" 1
• "Has your child's appetite changed?" 1
• "Is your child more clingy or afraid to be separated from you?" 1
• "Have you noticed any regression in behavior, like bedwetting?" 1
• "Does your child complain of physical symptoms like headaches or stomachaches without clear medical cause?" 1

For Adolescents

• Incorporate questions into the HEADSSS framework (Home, Education, Activities, Drugs, Sexuality, Suicide/depression, Safety) 1
• Ask about new or increased substance use 1
• Inquire about risk-taking or sexual behaviors 1

Validated Screening Tools to Use

Use the PTSD Checklist for DSM-5 (PCL-5) or the Clinician-Administered PTSD Scale (CAPS) as the gold standard structured interview, which assesses frequency and intensity of all 17 PTSD symptoms using behaviorally anchored rating scales. 6, 5

• The PTSD Reaction Index Brief Form for known trauma exposures 1
• The Pediatric Traumatic Stress Screening Tool for primary care settings 1

Critical Pitfalls to Avoid

• Never rely solely on observable behaviors, as most PTSD symptoms (intrusive thoughts, avoidance) are internal and not externally expressed 1
• Always ask directly about symptoms rather than waiting for patients to volunteer information, since avoidance is a core PTSD criterion 1
• Parents and teachers consistently underestimate children's distress after trauma, so always screen the child directly when age-appropriate 1
• Ask about ongoing stressors and the family's current situation, as parental distress impairs their ability to recognize children's needs 1
• Screen for comorbid conditions including depression, anxiety disorders, and substance use, which are extremely common in PTSD 2, 5
• For patients with sleep disturbance, specifically ask about nightmares and consider screening for obstructive sleep apnea 2, 5

Comorbidity Screening

• Screen for major depressive disorder symptoms 5, 7
• Ask about panic attacks and agoraphobia 1
• Inquire about substance use (alcohol, tobacco, drugs) 1, 5, 7
• Assess for suicidal ideation, especially with comorbid depression 5